First Aid - Part 2

( Originally Published 1940 )

Bleeding

The best way to control a hemorrhage is to apply direct pressure upon the bleeding point. Use a sterile gauze compress if it is available; if not, use a clean cloth. Bleeding from an artery occurs in spurts. From a small artery, such as that of a finger or scalp, the bleeding will be stopped by application of direct pressure. The pressure should be maintained until bleeding has ceased. If an artery in an arm or leg is cut, a tourniquet should be placed around the limb, just above the wound. The tourniquet should not be kept on longer than a half-hour at a time or gangrene of the limb may result. Bleeding from an artery is a serious matter and requires medical care after emergency treatment.

As contrasted with arterial bleeding, bleeding from a cut or injured vein is in a steady flow. Heavy pressure with gauze or a clean cloth should be applied directly on the wound. Never apply a tourniquet.

In most cases of bleeding only the smallest vessels, known as capillaries, are injured. Such bleeding can be checked by putting a pad of gauze or clean cloth on the wound and applying steady pressure. The bleeding of small abrasions and razor cuts can be stopped by application of a styptic pencil.

Nosebleeds, occurring spontaneously and without previous injury, may be a sign of a general infection or disorder. In children, repeated nosebleeds may be a sign of acute rheumatic fever. A doctor's attention is imperative. The occasional nosebleed in children and adults is generally from a small surface vein injured by sneezing, picking, etc. In women, periodic nosebleeds may be associated with menstruation. A slight nosebleed can be stopped simply by tightly compressing the nostrils. If this is not effective, a narrow strip of gauze or a plug of cotton may be inserted into the nostril and compressed with the fingers. Lying with the head raised and a cold compress over the nose may also help. Repeated or severe nosebleeds require medical examination.

Fractures

In handling a fracture it is important to prevent a simple fracture from becoming compound (one in which the broken bone tears through the skin). This may be avoided by placing splints along the bone before moving the patient. If the fracture is compound, cover the wound with clean gauze or cloth before applying the splints. Don't try to set a fracture. That is a doctor's business.

Sprains

Sprains of the ankle or wrist should be treated by immersing the joint immediately in a basin or pail of very cold water for 20 minutes or so. The cold water tends to prevent marked swelling and will also relieve much of the pain. A bad sprain will require splinting or strapping by a physician.

Shock and Unconsciousness

The causes of shock are many, and the condition is serious. Call a physician or an ambulance at once. Keep the patient lying down and loosen tight clothing around the neck. If the skin is pale and clammy and the pulse weak, apply heat in the form of blankets, hot-water bottles or hot bricks. Wrap hot objects well before applying, so as to avoid burning the patient. If he can swallow, give hot drinks. Hot coffee or tea is particularly good. One teaspoonful of aromatic spirits of ammonia in half a glass of water is also helpful.

If the skin is hot and flushed or if there is bleeding, no stimulants should be given. Keep the patient quiet, lying flat on his back until medical aid arrives. This is the most important rule in every case of shock or unconsciousness.

Artificial respiration should be used only for unconsciousness caused by drowning, gas or electric shock, when breathing has ceased.

Artificial Respiration

The Prone Pressure Method first advanced by Sir Edward Sharpey Schafer is recognized as the most efficient and safest method.

Remove at once from the patient's mouth and throat all foreign bodies such as false teeth, gum, etc. If the mouth is tightly shut, do not waste time trying to open it. The technique of resuscitation must be begun immediately. Every moment of delay is serious.

Standard Technique

1. Lay the patient on his belly, one arm extended directly overhead, the other arm bent at the elbow, and the face turned outward and resting on hand and forearm, so that the nose and mouth are free for breathing.

2. Straddle the patient's thighs, with the knees at a level slightly above the patient's knees.

Place the palms of the hands on the small of the patient's back with fingers resting on the ribs, the little finger just touching the lowest rib, with the thumb and other fingers resting in a natural position.

3. With the arms held straight, swing forward slowly, so that the weight of your body is gradually brought to bear upon the patient. The shoulder should be directly over the heel of the hand at the end of the forward swing. Do not bend the elbows. This step should take about two seconds.

4. Swing immediately backward so as to remove the pressure completely.

5. After two seconds swing forward again. The forward and backward swings should be repeated in regular rhythm so that about 15 complete movements are made each minute.

6. Continue artificial respiration without interruption, changing operators when necessary, until natural breathing is restored—if necessary, four hours or longer.

7. As soon as artificial respiration has been started and while it is being continued, an assistant should loosen any tight clothing about the patient's neck, chest or waist. Keep the patient warm. Do not give any liquids whatever by mouth until the patient is fully conscious.

8. Resuscitation should be carried on at the nearest possible point to where the patient received his injuries. He should not be moved from this point until he is breathing normally, of his own volition, and then moved only in a lying position.

g. A brief return of natural respiration is not a certain indication for stopping the resuscitation. Not infrequently the patient, after a temporary recovery of respiration, stops breathing again. The patient must be watched, and if natural breathing stops, artificial respiration should be resumed at once.

Wounds

Wounds require immediate treatment because of the danger of infection. A slight cut simply requires the application of a good antiseptic and a Band-Aid or similar covering. Deeper cuts should first be treated by immersing the wounded part in running cold water. This will mechanically remove many germs. Then an antiseptic should be applied. Larger or deeper wounds are more likely to become infected. Germs may be removed from the area adjacent to the wound by washing with clean gauze soaked in soap (tincture of green soap, if available) and water. The soap and water re-move germs and grease near the wound. An antiseptic solution should then be applied to the wound, and finally a sterile gauze bandage should cover it.

Do not use a dressing saturated with a strong antiseptic solution, as it may damage the skin. (Saturated aqueous solution of boric acid is a mildly active nonirritating antiseptic. It may safely be used for wet compresses and also in the eye. Never use any other antiseptic solution in the eye unless so directed by your physician.)

All deep or penetrating wounds require immediate surgical treatment. It may be necessary to remove foreign objects, to suture the skin or blood vessels, and to administer tetanus antitoxin if the wound has been caused by a dirty object. The antitoxin must be administered as soon after the wound was produced as possible. Delay may be fatal.

Antiseptics

Although hundreds of "antiseptics" are advertised every year in America, the ideal antiseptic, one that quickly destroys germs, that does not harm the tissues and that is also cheap, is yet to be discovered. The number and variety of substances that have been used to kill disease-producing organisms are staggering. An antiseptic that kills bacteria quickly in a test tube may not be equally effective when used on the body. And conversely, antiseptics that destroy germs on the body may not demonstrate their effectiveness in a test tube. Bacteria themselves vary in their susceptibility to different antiseptics; some are killed readily by weak solutions; others may actually grow in solutions that are deadly to most varieties. Furthermore, certain highly effective germicides or antiseptics are limited in their usefulness because they are too poisonous for human beings.

Despite the complexity of the subject and the lack of full knowledge, there is enough information available to enable us to make a suitable choice of an antiseptic. Although iodine is surpassed in some respects by other substances, it is still one of the best of first-aid antiseptics.

Iodine irritates open tissues and in sufficient concentration readily burns the unbroken skin. It is a highly reactive element and will therefore combine with a great many different materials. It is precisely because it is so reactive that iodine is a good germicide-if bacteria or fungi are accessible to it, it will combiné with them, too.

Iodine can be applied to the skin in two ways: by evaporation of an alcoholic solution ("tincture"), or by precipitation from a watery solution, which does not require drying.

Among the mercurial antiseptics there are preparations which are germicidal and have a greater bacterial growth-inhibiting power than iodine. The most powerful of these are the Merphenyl compounds, especially Merphenyl Borate and Merphenyl Nitrate. Unfortunately, the latter are, at present, sometimes difficult to obtain, whereas iodine is available all over the world, and is less expensive. Not quite so efficient as the Merphenyl products but still superior to iodine, are Metaphen, Mercarbolide, Mercresin and Merthiolate.

The following are the best of the known antiseptics. They contain alcohol, or alcohol and acetone; therefore they sting when applied to a wound. Because they penetrate skin and tissues more readily they are to be preferred to the watery solutions, which are less irritating. (Alcoholic solutions are known as tinctures; they should be kept in tightly stoppered bottles.)